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Sonja Jandrokovi&cacute;,1,2 Sania Vidas Pauk,1 Dina Lešin Ga&cacute;ina,1 Ivan Skegro,1,2 Martina Tomi&cacute;,3 Sanja Masnec,1,2 Tomislav Kuzman,1,2 Miro Kalauz1,2 1Department of Ophthalmology, University Clinical Hospital Center Zagreb, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, CroatiaCorrespondence: Sania Vidas Pauk, Department of Ophthalmology, Zagreb University Hospital Center, Kišpati&cacute;eva 12, Zagreb, 10000, Croatia, Tel +385989371397, Fax +38512388430, Email sania_vidas@yahoo.comPurpose: To evaluate the effect of switching from preserved prostaglandin analog-timolol fixed combinations (PG-timolol FCs) to preservative-free latanoprost-timolol FC (PF-LT) on intraocular pressure (IOP), ocular surface health, and tolerability in glaucoma and ocular hypertension (OH) patients with the concurrent ocular surface disease (OSD).Methods: This was a longitudinal, prospective, interventional, real-life study among 42 patients. Up to 3 visits were planned, at baseline, 30, and 90 days to assess efficacy on IOP decrease and local tolerance. The severity of OSD symptoms [Ocular Surface Disease Index (OSDI) questionnaire], subjective drug tolerability [visual analog scale (VAS)], conjunctival hyperemia (McMonnies scale), and tear break-up time (TBUT) were the main parameters assessed.Results: Data from 36 patients were available for statistical analysis. IOP was significantly reduced at day 30 and day 90 compared to baseline (16 vs 14 vs 14 mmHg, p < 0.001). Significant improvement was demonstrated in OSD symptoms, signs, and VAS scores from the baseline to the second and third visits. Median OSDI (27.1 vs 9.6 vs 4.2, p < 0.001), conjunctival hyperemia (2 vs 1 vs 1, p < 0.001), corneal surface staining (p < 0.001), and conjunctival staining scores (p < 0.001), and the percentage of patients with eyelid and periocular hyperemia (61.1 vs 12.5 vs 2.8%, p < 0.001), significantly decreased. TBUT (4 vs 5 vs 6 s, p < 0.001) and VAS score regarding tolerability (5 vs 2 vs 1, p < 0.001) significantly increased.Conclusion: A switch from preserved PG-timolol FCs to PF-LT improved tolerability and optimized IOP control, providing better adherence with greater chances of treatment success.Keywords: glaucoma, prostaglandin analogs, preservative, benzalkonium chloride, preservative-free, fixed combinations

Running is a common physical activity of an aerobic nature that is carried out mostly outdoors and presents a healthy lifestyle. However, the positive effect of running often masks the downsides of potential addiction that can compromise an individual's physical, mental, and social functioning. Most often there is a thin and unclear line separating passionate athletes and running addicts. Thus, it is necessary to educate the running community to raise awareness of the negative effects of over-training, prevent complications and injuries and to seek the necessary help.The study sample consisted of runners from the Croatian population of both genders, aged 18 to 75, who have been running for more than a year. The respondents were divided into groups according to the favorite length of the racing race. Groups were compared in terms of nutritional supplements usage, running-related injuries, as well as the impact of Covid-19 pandemic on their running volume. Difference between groups in Exercise Addiction Inventory (EAI) questionnaire outcome scores was also accessed.The statistical analysis included the answers of 644 people of both genders, among which 309 (48%) men and 335 (52%) women. The average age of the respondents was 42 years (18-75), and the average age of running was 5 years (1-42). Only among the respondents who started running most recently (1 to 10 years), and those who run the longest races (longer than 100 km) were found to use nutritional supplements significantly more (71.43%, P0.001) and sustained injuries associated with running more than rest of the groups (100%, P=0.013). Due to the pandemic, only respondents who have been running for the longest time (31-42 years) and prefer to run races from 21 to 42 km significantly reduced the amount of training (75%, P=0.037). The risk for addiction was significantly positively associated with the use of dietary supplements, the favorite length of the race and the frequency of injuries, while there was no association with the length of running.Running is a high-risk sport for addiction development. All the benevolent attitudes and positive effects of running often mask the downsides of addiction that can compromise an individual and his or her physical, mental, and social functioning. Due to the high percentage of addiction risk of 25%, it is necessary to educate the racing community to raise awareness of the negative effects of overtraining, prevent complications and seek the necessary help.

Purpose: To determine the 6-month effect of conventional (CXL30) and accelerated crosslinking with UVA intensity of 9mW/cm2 (CXL10) on corneal stability and visual function and to investigate whether there was a difference in ABCD grading system parameters regarding the two procedures. Setting: Prospective study. Methods: Twenty-seven eyes of 25 patients with a documented diagnosis of keratoconus (KN) progression defined by the instructions from the Global Consensus on Keratoconus and Ectatic Diseases were included. Patients were selected to undergo either CXL 30 or CXL 10 procedure. After epithelial debridement, soaking the cornea with riboflavin 0.1%/hydroxypropyl methylcellulose 1.1% for 10 min. at 2-minute intervals, the surgeon decided to proceed with UVA irradiance of 3mW/cm2 or 9mW/cm2 . At the baseline visit and the follow-up visits after one month (mo.) (V1), three (V2), and six mo. (V3) postoperatively, all the patients underwent complete ophthalmic examination, including uncorrected visual acuity (UDVA), best- corrected visual acuity (BCVA), and corneal tomography (Pentacam HR ; Oculus, Wetzlar Inc, Germany). Results: In the CXL 30 group, all the parameters from ABCD grading system significantly changed from baseline visit to V3 ; parameter A decreased (2.5 vs. 2.6 vs. 2.4 vs. 2.5, p= 0, 048), B increased (4.66 vs. 4.54 vs. 5.03 vs. 4.99, p=0.01), C increased (1.52 vs. 2.09 vs. 2.36 vs. 2.14, p

Objective Previously we have shown that plasma protein N-glycosylation is changed in children at the onset of type 1 diabetes. In this study, we aim to identify N-glycan changes in adults with T1DM, compare them to those in children, and investigate their associations with disease duration, complications, glycaemic status, and smoking. Methods Serum protein N-glycans from 200 adults with type 1 diabetes and 298 healthy controls were analysed using ultra-high performance liquid chromatography and divided into 39 directly measured glycan groups from which 16 derived traits were calculated. Results Compared to healthy controls, subjects with type 1 diabetes showed differences in 19 glycan groups and a decrease in monogalactosylated, an increase in digalactosylated, monosialylated, and antennary fucosylated derived traits, from which changes in monogalactosylation and seven directly measured traits overlapped with previously reported in children. Changes in four directly measured and two derived traits previously seen in children were not detected in adults. HbA1c was positively associated with sialylated and highly branched structures, whereas N-glycome was not influenced by disease duration or diabetic complications. Conclusions Our results suggest potential N-glycome involvement in different stages of type 1 diabetes, including processes underlying its development, the disease itself, as well as those occurring after disease establishment.

The COVID-19 epidemic and earthquakes in Croatia during 2020 suddenly disrupted everyday life and caused psychological disturbances in population. The purpose of the present study was to assess the prevalence of anxiety symptoms and the level of treatment adherence in glaucoma patients during the pandemic. The paper also aimed to evaluate the correlation between anxiety symptoms, treatment adherence and treatment outcomes in the studied cohort.This cross-sectional study was conducted among primary open-angle glaucoma (POAG) patients at the Department of Ophthalmology, Zagreb University Hospital Center, during one year. The Beck Anxiety Inventory (BAI) was used to measure the level of anxiety symptoms. Treatment adherence was estimated by the Culig adherence scale (CAS). Glaucoma damage was determined for each patient from the level of structural and functional impairment of the worse eye, by retinal nerve fiber layer (RNFL) thickness and mean defect (MD), respectively. Statistical analyses were performed, with a P value of less than 0.05 considered being statistically significant.This study included 113 POAG patients, with a mean age of 65.89 years. The median of the BAI total score in all patients was 10. According to the CAS, 60.2% of patients were non-adherent to glaucoma treatment during the COVID-19 outbreak. The BAI total score was significantly negatively related to adherence to local glaucoma treatment (p0.001). A significant negative association was also observed between adherence and MD (p=0.017), while no correlation was found between adherence and RNFL thickness (p=0.228).Considerable proportion of patients with glaucoma have shown non-adherence to treatment during the COVID-19 pandemic. Anxiety severity was associated with lower adherence, thus indirectly influencing therapeutics outcomes. Special consideration should be given to the strategies promoting mental health and interventions focusing on treatment adherence in glaucoma patients in a time of emergencies.

Background and aims: Previous studies suggested that long-term perseverance of beta-cell function in patients with type 1 diabetes (T1DM) is associated with lower incidence of microvascular complications. The objective of this study was to evaluate preserved C-peptide secretion in patients with T1DM without overt chronic complications and to explore associations with resistin and uric acid as biomarkers of microvascular complication pathogenesis. ----- Materials and methods: We assessed residual beta-cell function in 164 T1DM patients (male/female = 91/73; age/diabetes duration range = 18-70/1-30 years) using an ultrasensitive C-peptide ELISA assay with detection limit of 2.5 pmol/L and total coefficient of variation (CV) 5,8% (Mercodia, Sweden). Serum level of uric acid was measured by enzymatic method (AU680, Beckman Coulter, USA) while resistin concentration was determined by the ELISA assay (Biovendor, Czech Republic). ----- Results: C-peptide secretors had shorter diabetes duration (5.1 vs. 16 years; p < 0,001), lower resistin (4.53 vs. 4.93 mg/mL p = 0.045), and higher uric acid (259 vs 238 μmol/L, p = 0.048) level than T1DM patients with no detectable C-peptide levels, while no differences in routine anthropometric and laboratory variables, including HbA1c, were observed. Although the proportion of C-peptide secretors significantly decreased across categories of diabetes duration (70%, 38%, 17% and 15% for

Aims: To evaluate the 15-year incidence of development and progression of diabetic retinopathy (DR) in type 1 diabetic patients (T1DM) and determine the associated risk factors. Methods: 123 T1DM were included in this prospective cohort study and followed for 15 years. Demographic, clinical, laboratory parameters, and retinal photographs were collected and analyzed. Risk factors for DR development and progression were identified using Cox regression analysis. Results: At baseline, 87 (71%) patients had no DR, and 36 (29%) had nonproliferative DR (NPDR). After 15 years, 54 patients (43.9% ; 29.3/1000 person- years) developed NPDR or progressed to proliferative DR (PDR) ; 24 (27.6%) developed new NPDR, and 30 (83.3%) progressed to PDR. HbA1c (HR = 1.48, p = 0.008) and urinary albumin excretion rate (AER) (HR = 1.58, p = 0.045) were associated with the risk of DR development and progression, and a protective association was found for HDL cholesterol (HR = 0.17, p = 0.021). The presence of DR at baseline (HR = 2.95, p = 0.023) was associated with the risk of its progression to PDR. Conclusions: The 15-year incidence of DR development and progression in T1DM is still very high, which points to the need for close monitoring of T1DM, especially those with higher HbA1c, higher AER, the initial presence of DR, and lower HDL cholesterol.

Aim To determine the diagnostic accuracy of non- invasive tear film break-up time (NIBUT) measured by the handheld lipid layer examination instrument. Methods 108 patients were enrolled in this cross- sectional study and divided into two groups: patients with dry eye (n = 57) categorized by the presence of dry eye symptoms obtained by Schein Questionnaire and minimally-one objective dry eye sign (tear film break-up time

Aberrant plasma protein N-glycosylation has been reported in children newly diagnosed with type 1 diabetes (T1D) and N-glycosylation has also been associated with poor glycaemic control and nephropathy in T1D. N-glycosylation features distinct for adult patients with T1D, however, remain to be assessed. In this study we compared the serum protein N-glycosylation between adult patients and corresponding healthy controls as well as examined the association of N- glycans with common diabetic complications, duration of the disease, glycaemic control, and smoking. Serum N-glycans were analysed by UPLC in 201 patients with T1D (18-70) and 298 healthy controls (18-79). N-glycome was divided into 39 glycan groups and 16 derived traits calculated based on structural similarities. Serum N-glycome in T1D subjects exhibited significant decrease in monogalactosylated and an increase in digalactosylated, monosialylated and antennary fucosylated structures, as well as changes in 19 directly measured N- glycan traits. None of the N-glycosylation features, however, correlated with the duration of the disease nor with the development or progression of microvascular complications, similarly to glycaemic parameters, excluding HbA1c. HbA1c was positively associated with sialylated and highly branched glycans, while the effect of smoking was observed through increased complexity of plasma N-glycome.This study shows that T1D associates with a multitude of changes in the N-glycome, reflecting the complexity of the disease. Some of the changes were previously described in newly diagnosed children, but a number of new are found to be present only in the adult patients: e.g., an increase in antennary-fucosylated structures commonly originating from alpha-1-acid glycoprotein, or a decrease in oligomannose structures associated with immunoglobulin M. Interestingly, glycans did not associate with the duration of the disease or with microvascular complications, while conversely poor glycaemic control and smoking were strongly reflected in the N-glycome. In general, this study provides a more comprehensive portrayal of N-glycan changes in adult patients with T1D and highlights changes in certain plasma proteins, but nevertheless warrants further research on N-glycosylation in T1D.

Aim To determine the diagnostic accuracy of non- invasive tear film break-up time (NIBUT) measured by the handheld lipid layer examination instrument. Methods 108 patients were enrolled in this cross- sectional study and divided into two groups: patients with dry eye (n = 57) categorized by the presence of dry eye symptoms obtained by Schein Questionnaire and minimally-one objective dry eye sign (tear film break-up time

Patients with diabetes have up to five times higher incidence of cataract, mainly at a younger age, and cataract in these patients progresses more rapidly than senile cataract, especially in eyes affected with sight-threatening diabetic retinopathy (DR). This study aimed to investigate the risk factors associated with cataract development in patients with type 2 diabetes (T2DM). This case-control cross-sectional study included 90 T2DM (56M/34F). Metabolic risk factors glycated hemoglobin (HbA1c), total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides were determined using routine laboratory methods. Blood pressure was measured with a mercury sphygmomanometer after a 10-min resting period. Lens opacity was graded according to the Lens Opacity Classification System version III (LOCS III). According to the LOCS III, patients were divided into two groups: group 1—patients with clear crystalline lens, and group 2—patients with initial cataract. Compared to patients with a clear crystalline lens, those with initial cataract had longer diabetes duration (p = 0.002), higher HbA1c (p = 0.037), higher total cholesterol (p = 0.029), higher diastolic blood pressure (DBP) (p = 0.014), and lower creatinine clearance (p = 0.017). Cataract was positively associated with diabetes duration (p = 0.001), HbA1c (p = 0.035), LDL cholesterol (p = 0.042), and DBP (p = 0.009), while negatively with creatinine clearance (p = 0.005). Logistic regression analysis showed that the influence of DBP (AOR = 1.06, p = 0.014) and creatinine clearance (AOR = 2.93, p = 0.045) on cataract development remained significant even after adjustment for diabetes duration and HbA1c. Diabetes duration and various metabolic risk factors, particularly poor glycemic control, hypercholesterolemia, DBP, and diabetic nephropathy's coexistence, are associated with cataract development in T2DM.

Aim: To enquire whether patients with dry eye symptoms also report dry skin, whether their perception could be corroborated with objective measurement, and whether dry eye disease might be suspected based on patients' anamnesis.Methods: This cross-sectional study included 50 subjects (25 with and 25 without dry eye symptoms). Schein questionnaire was used to determine the severity of dry eye symptoms. Ocular signs were assessed by conjunctival hyperemia, ocular surface staining, Meibomian gland expression, tear film lipid layer thickness, tear break-up time, lid parallel conjunctival folds, Schirmer test, and meibometry. Skin dryness was assessed by patients' perception of their facial skin dryness and measured by sebumeter.Results: Subjects without dry eye symptoms had self-reported oilier facial skin than those with dry eye symptoms (pConclusion: This study showed that ocular dryness was subjectively and objectively positively correlated to facial skin dryness - patients reliably described their skin condition: people with dry facial skin also had drier eyes.

Purpose: To determine the feasibility of non-invasive tear break-up time (NIBUT) assessment using the Handheld tear lipid layer thickness assessment instrument and compare it with the standard tear break-up time (TBUT) test and other dry eye tests.Subjects and methods: 108 subjects were enrolled, 56 with and 52 without dry eye symptoms. Schein questionnaire was used to determine the severity of dry eye symptoms. Ocular signs were assessed by NIBUT, TBUT, lipid layer thickness (LLT), lid-parallel conjunctival folds (LIPCOF), conjunctival hyperemia, and corneal staining.Results: Median NIBUT and TBUT, and other clinical test values significantly differed among the dry eye symptoms group and control group. NIBUT yielded the most significant difference between the groups (NIBUT: 7 sec vs. 17.5 sec, p < .001, Z = 5.94; TBUT: 5 sec vs. 10 sec, p < .001, Z = 4.38; LLT: p = .007; LIPCOF: p < .001, conjunctival hyperemia: p < .047, corneal staining: p < .010). Spearman's test showed a significant correlation between NIBUT and TBUT (p < .001), NIBUT and LLT (p = .001), NIBUT and LIPCOF (p = .019), NIBUT and conjunctival hyperemia (p = .002), and NIBUT and corneal staining (p = .012) in the dry eye symptoms group. NIBUT did not significantly differ among the three measurements in both groups of patients (p = .061, p = .096), while TBUT values did in the control group (p < .001). Short NIBUT values were the main predictors and indicators of dry eye complaints (AOR = 0.87, p < .001), superior to TBUT (AOR = 0.88, p = .008) and other tests even after adjustment for age and gender.Conclusion: NIBUT measured by Handheld instrument is a simple, accessible, practical, and, most of all, reproducible and objective method that might allow NIBUT assessment on a regular basis.

Central vision loss, photopsia, floaters, and macular edema in a highly myopic patient can easily be misinterpreted as high myopia complications. In atypical cases, detailed examination and a thorough diagnostic workup are required to establish the proper diagnosis, which is often beyond the scope of diagnoses initially considered., Careful examination of the patient by an experienced ophthalmologist, together with the use of adequate diagnostic protocols, results in accurate diagnoses and initiation of proper therapy, with the ultimate aim to preserve vision in the patient.

Increase in homocysteine (HCY) level may increase cardiovascular risk (CVR), partly because of an impact on apolipoproteins and inflammation. Absorption of vitamin B12, involved in the regulation of HCY level, decreases with vitamin D deficiency. A possible association of vitamin D with visceral obesity and HCY was studied. HCY, 25-hydroxyvitamin D, vitamin B12, lipids, and other diabetes-related markers, including lipid accumulation product (LAP), were tested in 612 type 2 diabetic patients divided into four groups (1st group: LAP ≤ Q1; 2nd group: Q1 < LAP ≤ Med; 3rd group: Med < LAP ≤ Q3, 4th group: LAP ≥ Q3) according to LAP quartiles (Q1 = 28.5; Med = 50.59; Q3 = 80.64). LAP as an index, combining waist circumference and triglycerides, is related to risk of metabolic syndrome, diabetes and CVR. In all statistical tests: ANOVA, Tukey post-hoc test, and stepwise multivariate linear regression, α=0.05 was considered as statistically significant. Significant difference in vitamin D and B12, and high-density lipoprotein (HDL) according to LAP groups was determined. HDL differed significantly between the 1st (1.56±0.27) and the 3rd (1.24±0.17), and between the 1st and the 4th (1.19±0.25) group, vitamin D between the 1st (67.21±11.87) and the 3rd (60.34±10.78), and between the 1st and the 4th (51.29±13.41) group, and vitamin B12 differed significantly between the 1st (319.33±158.71) and the 3rd (212.14±71.92) group. After stepwise regression two best predictive variables for vitamin D were glomerular filtration rate (GFR) (parR2=0.12) and LAP (parR2=0.07), for vitamin B12 HCY (parR2=0.07) and age (parR2=0.07), and for HCY GFR (parR2=0.23) and vitamin B12 (parR2=0.09). Vitamins D and B12 differed according to quartiles of LAP, implying an influence of central obesity on their levels. LAP was one of the main predictors of vitamin D, and vitamin B12 was among the best predictive variables for HCY. The relationship between vitamin D, vitamin B12 and HCY implies involvement of decreased vitamin D in increased CVR. Disclosure S. Ljubic: None. A. Jazbec: None. I. Cudina: None. M. Tomic: None. D. Rahelic: None.

Diabetic retinopathy (DR) is the leading cause of preventable blindness in working-age adults associated with devastating personal and socioeconomic consequences. The increasing use of anti-vascular endothelial growth factor (anti-VEGF) agents over the past decade and telemedicine implementation in systematic DR screening resulted in a decliningtrend of new blindness due to diabetes in several countries. Telemedicine is the remote delivery of healthcare services over the telecommunications infrastructure. It allows healthcare providers to evaluate, diagnose, and treat patients without the need for an in-person visit. Teleophthalmology is a telemedicine branch, mostly focused on diabetic retinopathy and retinopathy of prematurity. Screening for DR in Croatia is commonly performed annually, only by ophthalmologists using dilated slit-lamp biomicroscopic fundus examination. Due to the insufficient number of ophthalmologists and the lack of a formal call system, many diabetic patients do not perform annual screening. In an ideal DR screening model in Croatia, each diabetes center in university or general hospitals throughout Croatia (17 centers) would have one small digital fundus camera and an educated nurse who would perform dilated fundus photography. Electronic images from diabetes centers would be transferred for remote grading to the same hospitals’ ophthalmology departments or a central grading center for DR screening in Croatia. Grading for DR would be performed by an ophthalmologist, medical retina specialist. Patients would be annually invited by mail from the National Diabetes Registry to come to the nearest diabetes center for a fundus photographing and DR screening. Each patient with a positive result would be promptly referred to the medical retina specialist at the closest ophthalmology department for further examination and treatment.

The aim of this study was to investigate risk factors and role of systemic inflammation, dyslipidemia and obesity in development of diabetic retinopathy (DR) in type 1 and type 2 diabetes and determine the differences in risk factors between these two types of diabetes. 84 type 1 and 107 type 2 diabetic patients were included in this cross-sectional study. Diabetes duration, body mass index (BMI) and waist-to-hip ratio (WHR) were assessed. C- reactive protein (CRP), fibrinogen (FIB), glycated hemoglobin (HbA1c), fasting and postprandial blood glucose (fBG, ppBG), HDL and LDL cholesterol and triglycerides (TG) were determined using routine methods. HbA1cmedian was obtained by statistical analysis of the CroDiabNet data and used as a marker of long- term glycemic control. Albumin excretion rate (AER) was measured in a 24-hour urine collection. Ophthalmologic retinal examination included indirect slit-lamp fundoscopy, color fundus photography according to EURODIAB (EUROpe and DIABetes) protocol and optical coherence tomography. DR was positively related to diabetes duration (p < .001), HbA1cmedian (p < .001) and AER (p=.008) in type 1, and diabetes duration (p < .001), HbA1cmedian (p=.018), AER (p < .001), CRP (p=.048) and TG (p=.041) in type 2 diabetes. Regression analysis showed that diabetes duration (OR 1.20, p=.005) and HbA1cmedian (OR 6.92, p=.007) were the main predictors of DR in type 1, and diabetes duration (OR 1.17, p

This study aimed to assess the role of plasma homocysteine (Hcy) in the development of nonproliferative diabetic retinopathy (NPDR) in patients with type 2 diabetes (T2DM) without chronic kidney disease.This was a cross-sectional study that included 94 T2DM. Hcy, serum 25-hydroxy (25-OH) vitamin D, vitamin B12, and folate were determined by the CMIA method. NPDR was determined according to the EURODIAB retinal photography methodology and optical coherence tomography (OCT) of the macula.Compared to patients without NPDR, patients with NPDR had longer diabetes duration (p 0.001), higher Hcy (p 0.001), lower vitamin B12 (p = 0.028) and lower estimated glomerular filtration rate (eGFR) (p = 0.004). NPDR was positively associated with diabetes duration (p 0.001), HbAHigher Hcy is associated with NPDR and may play a role as a risk factor for its development in T2DM. Vitamins B12 and D seem to modify this association.

Results from studies investigating relationship between serum lipids and risk of development and progression of diabetic retinopathy (DR) in patients with type 1 diabetes (T1DM) are not consistent. The objective of this study was to explore the relationship between serum lipids and risk of development and progression of nonproliferative diabetic retinopathy (NPDR) in T1DM with normal renal function. A total of 103 T1DM with normal renal function, and before any interventions with lipid-lowering therapy, ACE inhibitors or angiotensin II receptor blockers were included in this study and followed for 41 months. Photodocumented retinopathy status was made according to the EURODIAB protocol. Patients who developed NPDR or progressed to proliferative retinopathy were older (44 vs 33 years, p

Latent autoimmune diabetes (LADA) could be misdiagnosed as type 2 diabetes (DM2). Lipids, apolipoproteins, adiponectin (APN), interleukin-6 (IL-6), homocysteine (HCY), other markers of DM, including antibodies, were tested in 276 patients with DM1, DM2 and LADA. Quartiles of lipid accumulation product (LAP) (Q1:≤21.23, Q2:(21.23, 40.69], Q3:(40.69, 92.02], Q4:>92.02) were calculated as: [waist (cm) - 65 for men/58 for women] x triglycerides (mmol/L)]. In all statistical tests: ANOVA and Tukey post hoc test, and stepwise multivariate regression, α=0.05 was considered statistically significant. ANOVA revealed significant differences in HCY, APN, IL-6 and apolipoprotein A1 (Apo A1) among DM types. Patients with DM1 (1.73±0.33) and LADA (1.66±0.38) had significantly higher values of HDL compared to DM2 (1.33±0.31). IL-6 was statistically increased in DM2 compared to DM1; Apo A1 was statistically increased in LADA (1.7±0.36) compared to DM2 (1.4±0.22), whereas HCY was decreased (LADA: 10.9±2.74 vs. DM2 18.2±9.44). APN was decreased in DM2 compared to the control group. Logistic regression for DM2 pointed to APN (OR=0.826; p=0.02), HCY (OR=1.202; p=0.08) and HDL (OR=0.142; p=0.08) as statistically significant predictors, whereas uric acid (OR=0.991; p=0.08) was a predictor of LADA. After stepwise procedure the best model for APN included HDL (R2=0.46), for HCY glomerular filtration (parR2=0.26) and Apo A1 (parR2=0.08), and for Apo A1 HDL (parR2=0.79) and fasting glucose (parR2=0.03). 60% of DM2 patients, but 10.5% of LADA were in the 4th LAP quartile. Patients in the 4th quartile had significantly lower values of APN and Apo A1 compared to 1th and 2nd quartiles; HCY was increased in 4th compared to the 1th quartile. Significantly increased HDL and Apo A1 and decreased HCY in LADA compared to DM2 uncover LADA prior to determination of antibodies. Only 10.5% of LADA patients in the 4th quartile pointed to a lower cardiovascular risk than in DM2. Disclosure S. Ljubic: None. A. Jazbec: None. I. Antal: None. I. Cudina: None. M. Tomic: None. M. Vucic Lovrencic: None.

The aim was to determine feasibility and reliability of noninvasive tear break-up time (NIBUT) assessment using handheld lipid layer examination instrument, and to compare it with standard tear break-up time (TBUT) test. Fifty patients were enrolled, 31 with and 19 without dry eye symptoms. Schein questionnaire was used to assess dry eye symptoms. During examination, three NIBUT measurements were performed on each eye using handheld instrument, followed by three TBUT measurements. Receiver operating characteristic curves, sensitivity, specificity and logistic regression analysis were generated. Median NIBUT values were significantly shorter in dry eye symptom group than in control group in all three measurements (9, 8 and 8 s vs. 21, 22 and 21 s; p, Cilj ovoga istraživanja bio je ispitati pouzdanost mjerenja neinvazivnog testa pucanja suznog filma (NIBUT) pomoću ručnog instrumenta za procjenu debljine lipidnog sloja suza te ovu metodu usporediti sa standardnim invazivnim testom (TBUT). U istraživanje je bilo uključeno 50 ispitanika, 31 sa simptomima suhog oka i 19 bez njih. Za procjenu simptoma suhog oka rabio se standardni Scheinov upitnik. Za vrijeme pregleda provedena su tri mjerenja NIBUT-a pomoću ručnog instrumenta, potom tri mjerenja TBUT-a. Statističkom obradom podataka generirane su ROC krivulje, osjetljivost, specifičnost i regresijska analiza. Prosječna vrijednost NIBUT-a bila je značajno kraća u skupini bolesnika sa simptomima suhog oka nego u kontrolnoj skupini u sva tri mjerenja (9, 8, 8 s prema 21, 22, 21s; p

Diabetes is one of the leading public health problems worldwide. Diabetic macular edema (DME) is the main cause of vision loss in patients with diabetes. Ideal metabolic control of diabetes is the primary goal of treatment and the basic way of preventing and stopping the progression of DME. Although laser photocoagulation has been the standard treatment of DME for nearly three decades, superior outcomes can be achieved with novel, intravitreal anti-VEGF and steroid therapy. Novel treatment option for DME depends on visual acuity and location/extent of macular thickening based on optical coherence tomography scans. According to the International Clinical Classification Scale, DME is divided into no center-involving DME and center-involving DME (CI-DME). New guidelines recommend intravitreal treatment as the treatment of choice for patients with CI-DME and moderate visual impairment. Patients with no CI-DME and mild visual impairment should be treated with modified ETDRS laser photocoagulation and closely observed. Vitrectomy is the treatment of choice for patients with a tractional component of DME. Nowadays, traditional treatment goal of preventing blindness in patients with DME has been changed by the new goal aiming to restore impaired vision, prevent further vision loss and improve visual function. Therefore, many trials addressing this new concept have been underway worldwide.

Previous studies suggested that total serum bilirubin levels are negatively associated with diabetic retinopathy (DR) and nephropathy in patients with diabetes mellitus. The objective of this study was to explore the relationship between serum total bilirubin levels and prevalence of DR in patients with type 1 diabetes (T1DM) and normal renal function. Study included 163 T1DM with normal renal function (urinary albumin excretion rate < 30 mg/24h, estimated glomerular filtration rate (eGFR) >60 mlmin-11.73m-2). Photodocumented retinopathy status was made according to the EURODIAB protocol. Patients with DR were older (49 vs 42 years, p=0.001), had higher systolic blood pressure (130 vs 120 mmHg, p=0.001), triglycerides (0.89 vs 0.77 mmol/L, p=0.01), and lower serum total bilirubin (12 vs 15 U/L, p=0.02) and eGFR (100 vs 106 mlmin-11.73m-2, p=0.03). In multivariate logistic regression analysis, only total serum bilirubin was significantly associated with risk of DR in our subjects (OR 0.88, CI 0.81- 0.96, p=0.006). These data suggest that serum total bilirubin levels are independently negatively associated with DR in T1DM with normal renal function. Prospective studies are needed to confirm whether lower serum total bilirubin has predictive value for the development of DR in T1DM with normal renal function.

The aim was to compare retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses in patients with primary open angle glaucoma (POAG), ocular hypertension (OH) and healthy subjects, and to investigate the role of GCC parameters in glaucoma diagnosis. Eighty-one patients were divided into four groups according to Hodapp-Parrish-Anderson classification: 26 OH, 22 early POAG, 10 moderate to advanced POAG, and 23 healthy subjects. All patients underwent RNFL and GCC thickness measurement using SOCT Copernicus HR. All RNFL and GCC parameters were significantly lower in POAG than in OH and healthy subjects, especially Average RNFL, RNFL Superior and Inferior, GCC Average, and GGC Inferior. Of all RNFL parameters, the highest area under the receiver operating characteristic curve (AUC) was recorded for Average RNFL, 0.906. GCC Average, and GCC Superior and Inferior had the overall highest AUCs (0.957, 0.955 and 0.946, respectively) with 100% specificity. The RNFL Average and Inferior and GCC Average, Superior and Inferior were identified as the main predictors for development of glaucoma (p=0.015 and p=0.014 vs. p=0.002, p=0.002 and p=0.003, respectively). In conclusion, GCC parameters showed a slightly better glaucoma discriminating ability and were found to be better predictors for development of glaucoma as compared with RNFL., Cilj je bio usporediti debljinu sloja živčanih vlakana mrežnice (RNFL) i kompleksa ganglijskih stanica (GCC) u bolesnika s primarnim glaukomom otvorenog kuta (POAG), okularnom hipertenzijom (OH) i u zdravih ispitanika te istražiti ulogu parametara GCC u dijagnostici glaukoma. Ispitanici su bili podijeljeni u četiri skupine prema Hodapp-Parrish-Andersonovoj klasifi kaciji: 26 ispitanika s OH, 22 s ranim POAG-om, 10 s umjerenim do uznapredovalim POAG-om i 23 zdrava ispitanika. Svim ispitanicima je izmjerena debljina RNFL-a i GCC-a primjenom SOCT Copernicus HR. Ispitanici s POAG-om imali su značajno niže vrijednosti debljine GCC i RNFL nego ispitanici s OH i zdravi ispitanici, osobito vrijednosti prosječnog RNFL-a te RNFL-a u gornjem i donjem kvadrantu. Od svih parametara RNFL najveće područje ispod krivulje (AUC) pripadalo je prosječnom RNFL-u, 0,906. Prosječni GCC te GCC u gornjem i donjem kvadrantu imali su ukupno najveće vrijednosti AUC-a sa 100% specifičnošću. Glavni prediktori za razvoj glaukoma su bili prosječni RNFL, RNFL u donjem kvadrantu, prosječni GCC te GCC u gornjem i donjem kvadrantu (p1=0,015 i p2=0,014 prema p3=0,002, p4=0,002 i p5=0,003). U zaključku, parametri GCC su bolje razlikovali glaukomske od neglaukomskih bolesnika te su se pokazali kao bolji prediktori razvoja glaukoma u odnosu na parametre RNFL.

Diabetes is one of the leading public health problems worldwide. Diabetic macular edema (DME) is the main cause of vision loss in patients with diabetes. Ideal metabolic control of diabetes is the primary goal of treatment and the basic way of preventing and stopping the progression of DME. Although laser photocoagulation has been the standard treatment of DME for nearly three decades, superior outcomes can be achieved with novel, intravitreal anti-VEGF and steroid therapy. Novel treatment option for DME depends on visual acuity and location/extent of macular thickening based on optical coherence tomography scans. According to the International Clinical Classification Scale, DME is divided into no center-involving DME and center-involving DME (CI-DME). New guidelines recommend intravitreal treatment as the treatment of choice for patients with CI-DME and moderate visual impairment. Patients with no CI-DME and mild visual impairment should be treated with modified ETDRS laser photocoagulation and closely observed. Vitrectomy is the treatment of choice for patients with a tractional component of DME. Nowadays, traditional treatment goal of preventing blindness in patients with DME has been changed by the new goal aiming to restore impaired vision, prevent further vision loss and improve visual function. Therefore, many trials addressing this new concept have been underway worldwide., Dijabetes je jedan od vodećih svjetskih javnozdravstvenih problema. Dijabetički makularni edem (DME) je glavni uzrok sljepoće u osoba oboljelih od dijabetesa. Idealna metabolička regulacija bolesti je primarni cilj liječenja i osnovni način sprječavanja i zaustavljanja progresije DME-a. Iako je laserska fotokoagulacija u posljednja tri desetljeća smatrana standardnim načinom liječenja DME-a, bolji ishod moguće je postići primjenom nove intravitrealne anti-VEGF ili steroidne terapije. Novi pristup liječenju DME-a ovisi o vidnoj oštrini i smještaju/veličini makularnog zadebljanja utvrđenog optičkom koherentnom tomografijom. Prema Međunarodnoj kliničkoj klasifikaciji DME se dijeli na DME koji ne zahvaća centar makule (ne CI-DME) i DME sa zahvaćenim centrom (CI-DME). Nove smjernice preporučuju intravitrealno liječenje kao prvi izbor liječenja za bolesnike s CI-DME i umjerenim padom vidne oštrine, dok bolesnike s ne CI-DME i blagim padom vidne oštrine treba liječiti modificiranom ETDRS laserskom fotokoagulacijom i pažljivo pratiti. Operativni zahvat vitrektomija izbor je liječenja bolesnika s trakcijski izazvanim DME-om. U današnje vrijeme je sprječavanje sljepoće kao tradicionalni cilj liječenja DME-a zamijenjen novim ciljevima, a to su oporavak oštećene vidne oštrine, sprječavanje daljnjeg slabljenja vida i poboljšanje vidne funkcije pa se danas u tu svrhu provode brojna znanstvena i klinička istraživanja širom svijeta.

AIMS: To determine whether cardiac autonomic dysfunction represents a risk factor for diabetic retinopathy (DR) development and progression in persons with type 1 diabetes mellitus (T1DM). ----- METHODS: The study comprised 154 normoalbuminuric persons with T1DM divided into two groups according to the DR presence: with and without DR. Cardiovascular autonomic functioning was measured at baseline using conventional and spectral analysis. Participants were re-examined for the DR presence 18months after. ----- RESULTS: The group with DR had longer disease duration compared to the group without DR (20 vrs 11.5years, p

Aims.To investigate the behaviour of adiponectin (ApN) in patients with type 1 and type 2 diabetic nephropathy.Methods.ApN and inflammatory and other markers of the metabolic syndrome were compared across diabetes types, albumin excretion rate (AER), and creatinine clearance (CrCl) categories in 219 type 1 and type 2 diabetic patients.Results.Significant differences among ApN levels according to AER were found in both types of diabetes (F=8.45,df=2,P<0.001). With the progression of albuminuria, ApN increased in type 1 and decreased in type 2 diabetes. Patients with decreased CrCl had higher ApN levels than those with normal CrCl in either type of diabetes (F=12.7,df=1,P<0.001). The best model for ApN (R2=0.9002) obtained from stepwise regression in type 1 diabetes included CrCl, BMI, WBC, CRP, and age, while in type 2 diabetes (R2=0.2882) it included ppPG, LDL, and UA.Conclusion.ApN behaved differently in relation to albuminuria, increasing with its progression in type 1 diabetes and decreasing in type 2 diabetes. It was however increased in the subgroups with decreased CrCl in both types of diabetes. Albuminuria seems to be more important than renal insufficiency in the definition of ApN levels in type 1 and type 2 diabetes.